Serving those who have served
Veterans have specific needs at the end of life
Lenard Brannon, 93, has been in and out of hospice care.
Each time his caretakers think the end is nearing, he rallies, explains Mel McMorris, a hospice volunteer who met Brannon over three years ago when McMorris was visiting Brannon’s wife, who has since died.
During a May 16 visit with McMorris in Brannon’s room at Lantern Park Nursing and Rehab Center in Coralville, Brannon, a World War II veteran, says he isn’t ready to go.
“I’m going to make it,” he says. “I’m not giving up.”
That fighting attitude is just one of the attributes McMorris, himself a Vietnam veteran, says is common among combat veterans at the end of their lives.
More than one in four people dying today, and about half of men, are veterans, says Sarah Neary, Volunteer Program Coordinator at Iowa City Hospice. For a variety of reasons, less than four percent of dying veterans receive Veterans Affairs hospice or palliative care. Caring for them often falls to civilian programs like Iowa City Hospice.
“Those community providers need to be educated and aware of what the issues might be, specifically for veterans,” Neary says.
Blanket statements about what people are going through are impossible, she says, but caregivers need to be aware of the possible things veterans are processing at the ends of their lives.
“When you’re approaching death, a big component of that is a life review and a reliving and sorting through your life experiences,” she says. “If you’ve seen combat, seen friends killed or have killed people yourself, those things can come up.”
LIFE IMPACTS DEATH
Issues are often unique to where and when a veteran served.
WWII veterans, for example, were treated as heroes when they came home. However, they were part of a culture of stoicism that meant many never discussed the things they saw or did.
For Vietnam veterans, being treated with disdain instead of as heroes when they returned home created a different set of issues. So did the guerrilla-type warfare they encountered, which meant enemies could be anywhere.
For some, their war experiences may become visceral. Those with Alzheimer’s or dementia may be mentally transported back in time.
All veterans may underreport both physical and emotional pain, due again to the stoicism emphasized in the armed forces.
“Depending on their individual experiences, on if they have post-traumatic stress disorder, on the work they’ve done in their lives to heal that experience — those things will have a huge impact on their death experience,” Neary says.
Iowa City Hospice recruited McMorris to develop a volunteer training program focused on veterans’ needs, which the organization has been presenting since 2007.
Since then, many other hospice organizations have begun focusing on veterans’ needs. In 2010, the National Hospice and Palliative Care Organization partnered with the VA to create the “We Honor Veterans” initiative, which closely matches many things Iowa City was already working on.
Today, 39 Iowa hospices have enrolled in the “We Honor Veterans” program. Iowa City Hospice is the only hospice in the state to have achieved a Level 3 status for its efforts. It is working toward Level 4, the highest level.
Iowa City Hospice’s initiative includes volunteer training, improving efforts to track veteran status, especially for women, whose veteran status often goes unacknowledged, and providing community education.
SAYING THANK YOU
One key component of their efforts is presenting a certificate of appreciation to every veteran Iowa City Hospice serves.
“Ceremony is one of the languages of the military. All that stuff really, really matters,” Neary says. “It’s just a piece of paper, but if it’s presented with sincere gratitude and acknowledgment of why you’re saying thank you, it’s incredibly meaningful for the patients and the families.”
Much of what hospice volunteers do is simply sitting with patients and their families and being willing to listen.
“We can’t fix anything,” Neary says. “But there is tremendous value in being present in a compassionate way.”
McMorris, 66, and his wife moved to Missouri last year after he retired from a career in realty. He served in combat in Vietnam when he was 19 and 20. He says he it wasn’t until he was in his 30s that he could talk about his experiences without breaking down. Healing has been a slow process that has lasted decades.
“A veteran told me, when you’re in a battle, the scrimmage may only last a few hours, but the memories and images last a lifetime,” McMorris said.
McMorris returned to Iowa City on May 15 to lead volunteer training. He told the 19 volunteers that they shouldn’t assume someone doesn’t want to talk about their military service, even if they never rarely discussed it with their family.
“We have all been given a God-given ability to listen. That’s the skill that is most valuable,” he says.
Iowa City Hospice needs more veteran volunteers like McMorris. Of 130 Iowa Hospice volunteers, less than 10 are veterans.
Yet a veteran is often the best person to help another veteran in hospice, Neary says.
“They don’t have to talk. There’s this unspoken understanding, which more often leads to an open dialogue,” she says.
That camaraderie was evident during McMorris’ visit with Brannon.
“That’s my army guy,” Brannon says of McMorris.
Brannon points at a framed photograph of himself in uniform as a young man during WWII.
“And that’s my Navy guy,” he says.
He and McMorris discuss the weather, Brannon’s granddaughter, the quality of the nursing home’s scrambled eggs. Brannon tells a story about identifying planes as a lookout on the WWII naval destroyer ship he served on for 33 months.
He points out the medals surrounding his photograph.
“I’m proud of those,” he says.
Brannon is diminutive — he boasts a recent weight gain put him at 84 pounds — and admits he tires easily these days. But he still walks on his own with the aide of a wheeled walker, complete with a basket to carry his oxygen tank.
“He was involved in some of the most well known battles of naval history in WWII. He has seen amazing things, scary things,” McMorris says of Brannon. “His life is pretty simple these days, but he still wants to talk about those things.”